title: SSRI versus bupropion effects on symptom clusters in suicidal depression: post hoc analysis of a randomized clinical trial.
abstract: OBJECTIVE
  Identifying the depression symptoms most closely associated with suicidal thoughts and which medications provide the fastest depression relief may help suicide prevention.
  
  
  METHODS
  Post hoc analysis of data from a randomized, double-blind, 8-week clinical trial of the selective serotonin reuptake inhibitor paroxetine controlled release (n = 36) versus the norepinephrine-dopamine reuptake inhibitor bupropion extended release (n = 38) was conducted in patients with DSM-IV major depressive disorder and past suicide attempt or current suicidal thoughts. Treatment effects on Hamilton Depression Rating Scale (HDRS) and Beck Depression Inventory symptom clusters were compared. We hypothesized that paroxetine would demonstrate a superior effect on nonsuicidal, affective/cognitive depression symptom clusters that our prior work found to be associated with suicidal thoughts and attempts. Data were collected from February 2005 to January 2010.
  
  
  RESULTS
  There was a treatment main effect on HDRS psychic depression (depressed mood, guilt, retardation, helpless, hopeless, worthless) (estimate = -2.2; 95% CI, -3.2 to -1.1; t67.16 = -4.01; P < .001), one of the clusters most strongly correlated to suicidal ideation. The net drug effect demonstrated that mean psychic depression score was 2.2 points lower after 1 week of paroxetine compared to bupropion treatment. The significance level of this effect was P < .001 at weeks 1 and 2, P = .012 at week 3 and P = .051 at week 4. Results for other depression scale factors were nonsignificant (P > .05).
  
  
  CONCLUSIONS
  The results require replication but suggest a pathway by which selective serotonin reuptake inhibitor treatment may exert a stronger effect compared with norepinephrine-dopamine reuptake inhibitor treatment on reduction of suicidal thoughts during initial weeks of pharmacotherapy in these higher risk patients.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT00429169.
authors.affiliation: Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, 1051 Riverside Drive, Box 42, New York, NY 10032 mgruneb@nyspi.columbia.edu.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Grunebaum
authors.forename: John G
authors.initials: JG
authors.lastname: Keilp
authors.forename: Steven P
authors.initials: SP
authors.lastname: Ellis
authors.forename: Katherin
authors.initials: K
authors.lastname: Sudol
authors.forename: Neal
authors.initials: N
authors.lastname: Bauer
authors.forename: Ainsley K
authors.initials: AK
authors.lastname: Burke
authors.forename: Maria A
authors.initials: MA
authors.lastname: Oquendo
authors.forename: J John
authors.initials: JJ
authors.lastname: Mann
mesh_terms: D000328:Adult; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects / Q000627:therapeutic use*; D016642:Bupropion / Q000009:adverse effects / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017374:Paroxetine / Q000009:adverse effects / Q000627:therapeutic use*; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000523:psychology*; D055815:Young Adult
chemical_list: D018687:Antidepressive Agents, Second-Generation; D016642:Bupropion; D003692:Delayed-Action Preparations; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors